Provider Demographics
NPI:1639187032
Name:DOMINGUEZ, GILBERT (R PH)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2901
Mailing Address - Country:US
Mailing Address - Phone:201-569-1345
Mailing Address - Fax:201-568-5354
Practice Address - Street 1:35 E PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2901
Practice Address - Country:US
Practice Address - Phone:201-569-1345
Practice Address - Fax:201-568-5354
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01919900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist